ASO Author Reflections: Preoperative Prediction of Postmastectomy Radiation Therapy After Neoadjuvant Systemic Therapy

Excerpt

Immediate breast reconstruction and postmastectomy radiation therapy (PMRT) each play an integral part in multimodal breast cancer treatment. With the increasing use of neoadjuvant systemic therapy (NST) in early-stage breast cancer, the indications for PMRT are affected, and this contributes to the complexity of immediate breast reconstruction planning. The choice between immediate or delayed reconstruction is dependent on the preoperative need for PMRT. Residual axillary lymph node involvement after NST is the main determinant for PMRT since these patients have an increased risk of locoregional recurrence.1 However, axillary lymph node status in patients treated with NST is unknown prior to mastectomy, and the decision to perform immediate breast reconstruction is made without knowledge of the pathologic axillary outcome. In the case of immediate breast reconstruction, PMRT can not only adversely affect the cosmetic outcome of the reconstructed breast but can also increase the complication risks depending on the type of reconstruction.2,3 Therefore, preoperative identification of patients who do need PMRT after NST is advantageous to enable adequate shared decision making regarding the timing and type of reconstruction. …